Your Company LOGO Here Manual Title: HSE Manual

Manual No.:
Your Company name
Date
Job Safety Analysis (JSA) Revision
No. Of Pages 1 of 2

LOCATION DATE
Work Activity (Job) Description Page 1 of 1
Work Sequence (Job Steps) Hazards or Potential Incidents Recommendations to Eliminate or Reduce Hazards
Visual inspection of the forklift Unauthorized use of the forklift, leaks, punctured Only certified and trained operators are to use the forklift, fill out a daily
tires, broken windows, hydraulic/oil/diesel levels inspection checklist, and report any and all deficiencies to your supervisor
aren’t acceptable. immediately. Rectify any and all deficiencies
Read/sign the JSA and hold a PJSM to plan every job Language barrier, miscommunication, many steps in The team leader and forklift are to manage the PJSM, communicate
and assign an identifiable spotter with a hi-vis vest one job. expected hazards, ask and answer questions.
Accessing forklift and pre-heating the engine, wait Slips, trips and falls, equipment failure, gauge Housekeeping, clean your safety shoes/boots, secure grip on handles, clean
and start the engine, watch gauge, fuel, hydraulic and malfunction, equipment overheating. forklift steps, register any abnormalities and report any issues with the
water levels. equipment.
Move the forklift. People, other vehicles/equipment, buildings and line Ensure good visuals, check your mirrors, turn on all lights at all times (day or
of fire. night), use a spotter and stay out of line of fire.
Proceed to work area. Operating at an unsafe speed, people, vehicles, Follow the speed limit (5KM/H) ensure good visuals, turn on all lights at all
equipment, buildings, and uneven road tight areas. times (day or night), and use a spotter.
Pick up load People, equipment, environment and material, load Use a spotter, be aware of your surroundings, follow SWL, follow the
exceeds the forklift’s SWL, picking up load spotter’s signals, secure load, ensure good line of sight and communication
incorrectly, slips, trip and falls, load isn’t secured, a with spotter(s), housekeeping, only one man gives signals to the operator,
forklift is incorrect for this job use a crane for the job
Travel with load to destination People, equipment, environment, other vehicles, Use a spotter, be aware of your surroundings, follow the speed limit
uneven road, jerking stones/rocks, line of fire, (5KM/H), and give right of way.
Putting the load down. People, equipment, environment, other vehicles, Only essential personnel around job site, use a spotter, lights on (Always),
material, line of fire, follow speed limit, and be aware of your surroundings.
Travel back/end of work day, park forklift People, equipment, environment, other vehicles, Use a spotter, be aware of your surroundings, follow the speed limit
uneven road, jerking stones/rocks, line of fire, (5KM/H), give right of way, refuel the forklift, arrive to parking area, park the
operating at an unsafe speed, raised forks forklift, lower the forks and shut off engine.
Personal Protective Equipment, Special Tools and Other Safety Equipment Required to do this Job
Hard Hats  Face Shield  Barricades  Fire Extinguishers  Others:
Safety Boots  Goggles  Apron Vest  Lockout/Tagout 
Safety Glasses  Safety Harness  Gloves  Work Permit Required 
JSA written by: Ghareeb S. Hassan Approved by:
Job Title: QHSE Rep Job Title:
The Following Personnel Have Participated in this JSA Review
1) 2) 3) 4)

5) 6) 7) 8)
Your Company LOGO Here Manual Title: HSE Manual
Manual No.:
Your Company name
Date
Job Safety Analysis (JSA) Revision
No. Of Pages 2 of 2